Dena Schulman-Green
PhD
Associate Professor
Director of the Florence S. Downs PhD Program
dena.schulman-green@nyu.edu
1 212 998 5786
Associate Professor
Director of the Florence S. Downs PhD Program
433 First Ave
New York, NY 10010
United States
Accepting PhD students
Dena Schulman-Green's additional information
-
-
Dena Schulman-Green, PhD, is an associate professor at NYU Rory Meyers College of Nursing. Her program of research focuses on the integration of palliative care into patient and family management of serious, chronic illness. She designed Managing Cancer Care as an intervention to help women with breast cancer and their family caregivers to manage cancer collaboratively with clinicians. Schulman-Green is well known for her role in developing the Middle Range Theory of Self- and Family Management of Chronic Illness to guide research on patient and family management of chronic illness. Schulman-Green’s work is rooted in her belief that healthcare goals should reflect personal goals and values.
Additional research interests include health-illness transitions, psychosocial issues in cancer survivorship, and tailoring research methods for vulnerable populations. Schulman-Green consults on qualitative and mixed methods studies nationally. Her work has been funded by the American Cancer Society, the National Institutes of Health, the National Palliative Care Research Center, and the Palliative Care Research Cooperative, among others. She is active in the American Academy of Hospice and Palliative Medicine and serves on the Editorial Board of the Journal of Pain and Symptom Management. Invested in mentorship and leadership development, Schulman-Green supervises PhD and postdoctoral research trainees.
Prior to joining NYU Meyers, Schulman-Green was faculty at the Yale School of Nursing for 18 years, initially as a Research Scientist and later as an Associate Professor. She also served as faculty for the Yale School of Medicine’s Palliative Medicine Fellowship and Interprofessional Palliative Care Education programs. She was instrumental in developing palliative care research and providing qualitative and mixed methods research support university-wide.
Schulman-Green received a PhD and an MS in gerontology from the University of Massachusetts Boston, an MA and EdM in counseling psychology from Columbia University, and a BA in psychology and religion from Boston University. She completed a post-doctoral fellowship in breast cancer and palliative care at the Yale School of Nursing under the mentorship of Drs. Ruth McCorkle and Elizabeth Bradley.
-
-
PhD, University of Massachusetts BostonMS, University of Massachusetts BostonEdM, Columbia University, Teachers CollegeMA, Columbia University, Teachers CollegeBA, Boston University
-
-
Palliative careChronic diseaseGerontologyGlobal
-
-
American Academy of Hospice and Palliative MedicinePalliative Care Research Cooperative GroupEastern Nursing Research SocietyGerontological Society of AmericaAmerican Psychosocial Oncology Society
-
-
Faculty Honors Awards
Suzanne Feetham Nurse Scientist Family Research Award, Eastern Nursing Research Society (2019)American Academy of Hospice and Palliative Medicine Poster Award (2017)Annie W. Goodrich Award for Excellence in Teaching, Yale School of Nursing (2017)American Academy of Hospice and Palliative Medicine Poster Award (2016)American Academy of Hospice and Palliative Medicine Poster Award (2010)Center for Disease Control Success Story Award (2010)Ellison Medical Foundation Aging New Scholar Award Nominee, University of Massachusetts Boston (2006)National Hospice and Palliative Care Organization Research Award (2004)Inducted into Sigma Phi Omega, Gerontology Honor Society (1999)Association for Gerontology in Higher Education/AARP Andrus Foundation Graduate Scholarship in Gerontology (1998)Columbia University General Scholarship Award (1993)Inducted into Psi Chi, Psychology Honor Society (1992) -
-
Publications
Goal setting as a shared decision making strategy among clinicians and their older patients
AbstractSchulman-Green, D. J., Naik, A. D., Bradley, E. H., McCorkle, R., & Bogardus, S. T. (2006). Patient Education and Counseling, 63(1), 145-151. 10.1016/j.pec.2005.09.010AbstractObjective: Older adults are less likely than other age groups to participate in clinical decision-making. To enhance participation, we sought to understand how older adults consider and discuss their life and health goals during the clinical encounter. Methods: We conducted six focus groups: four with community-dwelling older persons (n = 42), one with geriatricians and internists (n = 6), and one with rehabilitation nurses (n = 5). Participants were asked to discuss: patients' life and health goals; communication about goals, and perception of agreement about health goals. Group interactions were tape-recorded, transcribed, and analyzed using content analysis. Results: All participants were willing to discuss goals, but varied in the degree to which they did so. Reasons for non-discussion included that goal setting was not a priority given limited time, visits focused on symptoms, mutual perception of disinterest, and the presumption that all patients' goals were the same. Conclusion: Interventions to enhance goal setting need to address key barriers to promoting goals discussions. Participants recognized the benefits of goal setting, however, training and instruments are needed to integrate goal setting into medicine. Practice implications: Setting goals initially and reviewing them periodically may be a comprehensive, time-efficient way of integrating patients' goals into their care plans.Communication between physicians and family caregivers about care at the end of life: When do discussions occur and what is said?
AbstractCherlin, E., Fried, T., Prigerson, H. G., Schulman-Green, D., Johnson-Hurzeler, R., & Bradley, E. H. (2005). Journal of Palliative Medicine, 8(6), 1176-1185. 10.1089/jpm.2005.8.1176AbstractBackground: Few studies have examined physician-family caregiver communication at the end of life, despite the important role families have in end-of-life care decisions. We examined family caregiver reports of physician communication about incurable illness, life expectancy, and hospice; the timing of these discussions; and subsequent family understanding of these issues. Design: Mixed methods study using a closed-ended survey of 206 family caregivers and open-ended, in-depth interviews with 12 additional family caregivers. Setting/Subjects: Two hundred eighteen primary family caregivers of patients with cancer enrolled with hospice between October 1999 and June 2002 Measurements: Family caregiver reports provided at the time of hospice enrollment of physician discussions of incurable illness, life expectancy, and hospice. Results: Many family caregivers reported that a physician never told them the patient's illness could not be cured (20.8%), never provided life expectancy (40% of those reportedly told illness was incurable), and never discussed using hospice (32.2%). Caregivers reported the first discussion of the illness being incurable and of hospice as a possibility occurred within 1 month of the patient's death in many cases (23.5% and 41.1%, respectively). In open-ended interviews, however, family caregivers expressed ambivalence about what they wanted to know, and their difficulty comprehending and accepting "bad news" was apparent in both qualitative and quantitative data. Conclusion: Our findings suggest that ineffective communication about end-of-life issues likely results from both physician's lack of discussion and family caregiver's difficulty hearing the news. Future studies should examine strategies for optimal physician-family caregiver communication about incurable illness, so that families and patients can begin the physical, emotional, and spiritual work that can lead to acceptance of the irreversible condition.Nurses' communication of prognosis and implications for hospice referral: A study of nurses caring for terminally ill hospitalized patients
AbstractSchulman-Green, D., McCorkle, R., Cherlin, E., Johnson-Hurzeler, R., & Bradley, E. H. (2005). American Journal of Critical Care, 14(1), 64-70. 10.4037/ajcc2005.14.1.64Abstract• BACKGROUND: Although nurses are ideally situated to facilitate communication about prognosis and hospice referral among patients, patients' family members, and hospital staff, nurses do not always assume this task. • OBJECTIVE: To identify common obstacles to nurses' discussions of prognosis and referral to hospice care with terminally ill patients in the hospital setting. • METHODS: Data from a previous study were analyzed. In that study, a total of 174 experienced staff nurses working full-time in hospital practice areas where terminally ill patients routinely receive care at 6 randomly selected community hospitals in Connecticut participated. Each nurse completed a self-administered, cross-sectional survey. In this study, the open-ended responses of the nurses were examined by using content analysis and descriptive analysis. • RESULTS: The most common obstacles were unwillingness of a patient or the patient's family to accept the prognosis and/or hospice, sudden death or noncommunicative status of the patient, belief of physicians' hesitance, nurses' discomfort, and nurses' desire to maintain hope among patients and patients' families. • CONCLUSIONS: The reasons for noncommunication of prognosis and referral to hospice care by nurses are complex. Because limited discussion between clinicians and patients about prognosis and treatment options can reduce the likelihood of referral to hospice care, improved communication skills may result in more referrals and a smoother transition to hospice.Unlicensed staff members' experiences with patients' pain on an inpatient oncology unit: Implications for redesigning the care delivery system
AbstractSchulman-Green, D., Harris, D., Xue, Y., Loseth, D. B., Czaplinski, C., Donovan, C., & McCorkle, R. (2005). Cancer Nursing, 28(5), 340-347. 10.1097/00002820-200509000-00002AbstractAlthough unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice situations, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses' aides, and housekeepers (N = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationships with patients, interpreting patients' pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients' pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain and expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.Will older persons and their clinicians use a shared decision-making instrument?
AbstractNaik, A. D., Schulman-Green, D., McCorkle, R., Bradley, E. H., & Bogardus, S. T. (2005). Journal of General Internal Medicine, 20(7), 640-643. 10.1111/j.1525-1497.2005.0114.xAbstractOBJECTIVE: To examine experiences of older persons and their clinicians with shared decision making (SDM) and their willingness to use an SDM instrument. DESIGN: Qualitative focus group study. PARTICIPANTS: Four focus groups of 41 older persons and 2 focus groups of 11 clinicians, purposively sampled to encompass a range of sociodemographic and clinical characteristics. APPROACH AND MAIN RESULTS: Audiotaped responses were transcribed, coded independently, and analyzed by 3 reviewers using the constant comparative method. Patient participants described using informal facilitators of shared decision making and supported use of an SDM instrument to keep "the doctor and patient on the same page." They envisioned the instrument as "part of the medical record" that could be "referenced at home." Clinician participants described the instrument as a "motivational and educational tool" that could "customize care for individual patients." Some clinician and patient participants expressed reluctance given time constraints and unfamiliarity with the process of setting participatory clinical goals. CONCLUSIONS: Participants indicated that they would use a shared decision-making instrument in their clinical encounters and attributed multiple functions to the instrument, especially as a tool to facilitate agreement with treatment goals and plans.At the crossroads: making the transition to hospice.
AbstractSchulman-Green, D., McCorkle, R., Curry, L., Cherlin, E., Johnson-Hurzeler, R., & Bradley, E. (2004). Palliative and Supportive Care, 2(4), 351-360. 10.1017/s1478951504040477AbstractOBJECTIVE: Previous studies reveal that many terminally ill patients never receive hospice care. Among those who do receive hospice, many enroll very close to the time of death. Nationally, between 1992 and 1998, the median length of stay at hospice declined 27%, from 26 to 19 days. In our prior study of 206 patients diagnosed with terminal cancer and using hospice, we found that one-third enrolled with hospice within 1 week prior to death. Late hospice enrollment can have deleterious effects on patients and their family members. The aim of the present study was to characterize common experiences of patients and primary family caregivers as they transition to hospice, focusing on caregiver perceptions of factors that might contribute to delays in hospice enrollment. METHODS: We conducted in-depth interviews with a purposive sample of 12 caregivers selected from a population of primary family caregivers of patients with terminal cancer who enrolled with hospice in Connecticut between September 2000 and September 2001. Respondents represented different ages, genders, and kinship relationships with patients. Respondents were asked about the patient's care trajectory, how they first learned about hospice, and their experiences as they transitioned to hospice. NUD*IST software was used for qualitative data coding and analysis. RESULTS: Constant comparative analysis identified three themes common to the experience of transitioning to hospice: (1) caregivers' acceptance of the impending death, (2) challenges in negotiating the health care system across the continuum of care, and (3) changing patient-family dynamics. SIGNIFICANCE OF RESULTS: Identification of these themes from the caregivers' perspective generates hypotheses about potential delays in hospice and may ultimately be useful in the design of interventions that are consistent with caregivers' needs.Family perceptions of clinicians' outstanding practices in end-of-life care
Cherlin, E., Schulman-Green, D., McCorkle, R., Johnson-Hurzeler, R., & Bradley, E. (2004). Journal of Palliative Care, 20(2), 113-116. 10.1177/082585970402000208How Do Physicians Learn to Provide Palliative Care?
AbstractSchulman-Green, D. (2003). Journal of Palliative Care, 19(4), 246-252. 10.1177/082585970301900405AbstractMedical interns, residents, and fellows are heavily involved in caring for dying patients and interacting with their families. Due to a lack of formal medical education in the area, these house staff often have a limited knowledge of palliative care. The purpose of this study was to determine how, given inadequate formal education, house staff learn to provide palliative care. Specifically, this study sought to explore the extent to which physicians learn to provide palliative care through formal medical education, from physicians and other hospital staff, and by on-the-job learning. Twenty physicians were interviewed about their medical education and other learning experiences in palliative care. ATLAS/ti software was used for data coding and analysis. Analysis of transcripts indicated that house staff learn little to nothing through formal education, to varying degrees from attending physicians and hospital staff, and mostly on the job and by making mistakes.Psychosocial issues in palliative care: Physicians' self-perceived role and collaboration with hospital staff
AbstractSchulman-Green, D. J. (2003). American Journal of Hospice and Palliative Medicine, 20(1), 34-40. 10.1177/104990910302000110AbstractPsychosocial issues are a major part of palliative treatment, yet, due to inadequate training, physicians are often ill-prepared to address them. Twenty physicians were interviewed about the importance they placed on psychosocial issues and the perceptions they had of their role in addressing them. Several respondents felt psychosocial issues were important because they affect physical issues, enable holistic care, enhance relationships, impact care decisions, and can reduce patient and family stress. Other respondents did not feel psychosocial issues were their responsibility due to time constraints, their focus on physical care, their lack of expertise in this area, the patients' preferences for attending physicians, and a sense on the part of house staff physicians of not yet being "real" doctors. Collaboration with other hospital staff helped overcome some of these obstacles. Since physicians must often provide psychosocial care, improved training in addressing psychosocial issues is indicated.Physicians' feelings about themselves and their patients [3] (multiple letters)
Kennedy, J. S., Auster, S., Schulman-Green, D., Meier, D. E., Back, A. L., & Morrison, R. S. (2002, March 6). In JAMA (Vols. 287, Issues 9, pp. 1113-1114). 10.1001/jama.287.9.1113